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When applied to substance use disorders, the term rehabilitation covers the therapy needed after detox to help the individual change their behavior around intoxicating substances like drugs or alcohol. Addiction is a disease of the brain, which reinforces itself through compulsive behaviors to ingest intoxicating substances, which creates pleasure and a sense of reward by releasing neurotransmitters like serotonin and dopamine. Once a person has been tapered or weaned off their body’s dependence on these drugs to feel normal – the detox process – they must enter a rehabilitation program to understand how addiction affects them. Professional therapists and the social support of group therapy can help the person change their behaviors to avoid intoxicating substances and live a healthier life.
Although rehabilitation is a necessary component to help a person overcome addiction, there are numerous approaches to this kind of treatment. Options include residential or outpatient treatment; faith-based or secular groups; holistic options; and much more. Each treatment option should provide the individual with a sense of empowerment to stay sober and a support network to maintain that sobriety.
The National Institute on Drug Abuse (NIDA) recognizes four basic approaches to treatment. These could differ in the style of psychotherapy provided, whether or not they offer medication assistance, and how long they last.
Inpatient rehabilitation: Also sometimes called short-term residential treatment, this is one of the more common forms of treatment for substance abuse. The original residential treatment programs were 3-6 weeks, and many private insurance companies still at least partially cover that length of treatment. However, NIDA recommends at least 90 days, or three months, in substance abuse treatment (inpatient or outpatient) to fully change behaviors around substances. People who go through inpatient rehabilitation do best if they continue receiving emotional and social support through support groups and/or professional therapy.
Long-term residential care: This form of substance abuse treatment provides support and assistance fulltime; the individual in treatment lives in the facility until they have completed the program, which could take several months. In some cases, the length of stay is 6-12 months. This is because long-term residential treatment uses the concept of a therapeutic community (TC) to provide emotional and medical support during detox, then ongoing emotional and social support to change behaviors around cravings, symptoms, and lifestyle.
Outpatient rehabilitation: This form of substance abuse recovery works well for people who need to, or want to, remain at home during treatment because they have family or work commitments, or they have enough support avoiding drugs or alcohol at home that they do not need to move away from triggers that might lead to relapse. Outpatient rehabilitation programs require a specific number of therapy meetings per week – usually between one and three, although it can be as many as six – and may include medication assistance, like buprenorphine, to help the individual taper off their dependence on certain substances.
Intensive outpatient programs: Several therapy sessions are scheduled over a period of days or weeks (usually less than one month), lasting for several hours a day. The individual can live at home, but they typically must take time off work or school due to the time requirements of the intensive outpatient program (IOP). These programs are good alternatives to inpatient treatment. They provide social support and access to therapists at a level usually provided by inpatient rehabilitation while greatly reducing the cost of treatment, which makes IOPs more accessible.
Different rehabilitation programs may employ different therapeutic approaches to treatment, both in group therapy and individual therapy sessions. As a better understanding of addiction treatment enters the medical and psychological fields, types of therapy are being combined. The foundational types of therapy used in drug and alcohol rehabilitation are outlined below.
Cognitive Behavioral Therapy: While this style of therapy may be combined with other types of therapeutic treatment, like Motivational Interviewing, Cognitive Behavioral Therapy has proven to be one of the most affective approaches to overcoming substance abuse and staying sober. This type of therapy uses positive reinforcement for good behaviors, like avoiding drugs or alcohol, paired with negative reinforcement, like understanding withdrawal symptoms or hangovers as downsides of substance abuse. A therapist will guide their client through verbal analysis of their behaviors and the effects these behaviors produce. This form of therapy also explores the conflict between how a client wants to act and what they actually do.
Motivational Interviewing: Developed to help problem drinkers understand that their patterns of substance abuse could cause social and health problems, and help them overcome resistance to entering treatment, Motivational Interviewing (MI) has evolved to address other kinds of addiction too. It is especially effective for adolescents struggling with substance abuse issues because this age group does not have the agency to refuse treatment. The approach uses questions, so the therapist can guide their client to an understanding of how patterns of drug or alcohol consumption cause problematic behaviors, situations, and have long-term health consequences. The focus is on collaborating with the client, rather than confronting them.
Contingency Management: This form of therapy uses positive reinforcement in the form of specific rewards, like vouchers or prizes, to help those in therapy feel rewarded for taking appropriate steps in their drug addiction treatment. This form of therapy works well, according to NIDA, for those overcoming alcohol, stimulant, opioids, nicotine, or marijuana addiction. Incentives-based therapy helps people overcoming substance abuse want to stay in treatment, so there is a higher treatment retention rate.
Family therapy: This form of therapy works with the whole family dynamic, so environmental triggers for addiction and other mental health problems can be understood, behavior can be changed, and trust in the family unit can be rebuilt. This form of therapy also helps the family better support their loved one while they undergo treatment in a rehabilitation program.
There are many substances that do not have medications to ease the body off dependence on them; however, there are important pharmacological treatments available for people struggling with alcohol use disorder, opioid addiction, and tobacco addiction, which can make detox and rehabilitation more effective. These drug treatments replace the addictive substance and then help the brain balance neurochemistry on its own by slowly tapering the replacement medication until the individual’s body no longer needs the presence of drugs to feel normal.
Common drugs used in MAT include:
The National Center for Complementary and Integrative Health (NCCI), a division of the National Institutes of Health (NIH), lists dozens of therapies based in gentle touch, nutrition, herbal medicine, energy healing, and more. According to NCCI, about 38 percent of American adults use some form of holistic, alternative, or complementary treatment for all kinds of ailments; this includes treatments to overcome substance abuse and maintain sobriety. Many rehabilitation programs are beginning to use alternative therapies to aid in a more balanced approach to treating the entire individual while they work to end their addiction.
Some types of holistic treatments provided by rehabilitation programs include:
A support group is a gathering of similar people who help each other through the recovery process. Support groups are important after a rehabilitation program is completed, so individuals can maintain social support in a group of peers. They can also be a vital component of drug rehabilitation during treatment, especially outpatient treatment.
A Washington Times article reports that 84 percent of the world participates in some form of faith, religious denomination, or worship. A PEW Research survey of 35,000 Americans found that nearly 71 percent reported being Christian, including evangelicals and Catholics. However, the US has long been home to many faiths, including Judaism, Islam, Buddhism, and Hinduism. Faith represents a large part of life for millions of Americans, so it should be unsurprising that numerous rehabilitation programs include a component of religious worship or belief in a higher power. This understanding of life and the world helps many people overcome substance abuse.
Alcoholics Anonymous and the 12-Step model: AA is a support group founded on 12 Steps created to help people struggling with alcohol use disorder overcome the condition. Many 12-Step-based programs exist today, helping those who struggle with other kinds of addiction as well. The famous 12 Steps are:
While the Anonymous support groups began with Alcoholics Anonymous, there are a dozen specific types of groups, covering compulsive behaviors and substance abuse. These are:
Salvation Army: Founded on Christian faith, the Salvation Army has provided substance abuse treatment services for free for over 100 years. Treatment options include residential treatment at Harbor Light and other adult rehabilitation centers offering support groups. The focus of treatment with the Salvation Army is social, emotional, and spiritual. Most of their centers provide group and individual therapy, housing, and work opportunities. Charity-based rehabilitation programs do not accept government funding and instead run on donations.
Jewish Alcoholics, Chemically Dependent Persons and Significant Others (JACS): Formerly Jews in Recovery, this program uses founding principles in modern Judaism to help members of the faith overcome addiction to alcohol or drugs. The larger group of programs offer support and guidance through Judaism, with an evidence-based understanding of addiction as a disease and how chemical dependency can affect the Jewish community.
Millati Islami: A Muslim-based fellowship of men and women supporting each other through recovery and ending addiction to intoxicating substances, using the Path of Peace and other principles of Islam. While the central faith is Islam, the philosophical foundation of the support group is based in the 12 Steps.
One of the most important components of recovery is social support, and for many, this takes the form of attending a local support group. The concept of a support group began with the 12 Steps, but many have moved away from the faith-based program while retaining the idea that working together and supporting each other through recovery improves outcomes.
Rather than the 12 Steps, Self-Management and Recovery Training (SMART) uses four steps to help those in the support group maintain abstinence from alcohol or drugs. These steps are:
There are in-person meetings all over the US, and meetings are also available online. SMART was one of the first support group and addiction recovery self-help programs to avoid faith-based treatment and to instead focus on the medical understanding of substance abuse.
The concept of taking specific steps to completely overcoming an addiction has a great deal of power: the person entering rehabilitation or the support group has a plan laid out for them, so they can check off steps as they make progress. However, steps-based programs do not work for everyone; instead, a more generally supportive approach to maintaining abstinence or overcoming relapse works better for some. These programs do not rely on steps, but they still provide effective support for overcoming addiction and maintaining abstinence.
While many people benefit from attending a support group in person, this may not always work out. Some people travel for work; others may simply live too far away from the meeting that would work best for them. Sometimes, a person may not be emotionally or physically well enough to leave home but still needs support in recovery. Fortunately, with greater online access, many people have started support groups online.
While most insurance programs and states provide some coverage for rehabilitation programs of all kinds, there are specific populations who may need additional help. Certain organizations support specific demographics with financial coverage so people can enter a drug or alcohol rehabilitation program.